Name *

First Name

Last Name

Phone *

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

How would you like to get involved? *

Canvassing

Communications & Marketing

Data Entry

Event Planning / Staffing / Zoom Help

Phone Banking

Poll Watcher

Precinct Organizing

Tech Integrations (Website, Constant Contact, etc)

Write Elected Officials

Legal Services (I am an Attorney)

Spanish-Speaking / Another Language

Other (Please fill in the box below)

Opt-In *

When submitting this form, I give permission to be added to the Nassau County Democrats mailing list and email list. I understand that I can unsubscribe at any time and my information will remain private.